Year 2016 / Volume 108 / Number 2
Digestive Diseases Image
Rectosigmoid carcinoma presenting with a large small bowel fistula

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María Dolores Pérez Valderas, Óscar Nogales Rincón, Javier García Lledó, Leticia Pérez Carazo, Beatriz Merino Rodríguez, Ignacio Marín Jiménez, Cecilia González Asanza, Pedro Menchén Fernández-Pacheco,

Abstract
Introduction: Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the second leading cause of cancer deaths. Case report: A 44 year-old woman, native from Colombia, presented to the emergency room with abdominal pain, fever, watery diarrhea (around 10 bowel movements per day) and occasional rectal bleeding. She complained of an 8 Kg weight loss the last 12 months. She had been studied at another hospital over the preceding 12 months with a suspected diagnosis of inflammatory bowel disease (IBD). In December 2012 an abdominal TAC examination was performed at that institution and was informed as a mural engrossment of multiple terminal ileum loops suggestive of IBD (no radiological images were available). On physical examination, there were no peritoneal reaction signs or palpable masses, and bowel movements were preserved. A laboratory test showed microcytic anemia (Hb 6.1g/dl, MCV 49.9), without leukocytosis. Because of her recent history, a preferential colonoscopy was indicated. Colonoscopy showed an ulcerated neoplasm 20 cm above anal margin, which affected colon wall circumferentially and caused a stenosis rendering colonoscope passage impossible. A gastroscope was progressed through the stenosis. It showed a big size necrotic cavity which directly connected the colon with two small bowel loops by neoplastic entero-colonic fistulas (Fig.1). Histopathological report revealed a poorly differentiated adenocarcinoma. Computed tomography (CT) scans of the chest, abdomen and pelvis confirmed the rectosigmoid carcinoma with a large small bowel fistula (Fig. 2) without any other pathological finding. Discussion: Fistula between the colon and adjacent structures is a rare complication of colon cancer. It is the result of the primary tumor ulceration with either a peritoneal reaction or an organization of exudates that leads to an adherence of the adjacent structures and then the eventual perforation into the lumen of other organ (3,5). Radiological studies are the most sensitive techniques in the detection and characterization of a fistulous tract (1), whilst colonoscopy (2,4) allows direct endoscopic visualization and can obtain biopsies for histological study.
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Citation tools
Pérez Valderas M, Nogales Rincón Ó, García Lledó J, Pérez Carazo L, Merino Rodríguez B, Marín Jiménez I, et all. Rectosigmoid carcinoma presenting with a large small bowel fistula. 3729/2015


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Publication history

Received: 15/02/2015

Accepted: 05/03/2015

Published: 01/02/2016

Article revision time: 16 days

Article editing time: 351 days


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